Maternal near miss and mortality due to postpartum infection: a cross-sectional analysis from Rwanda

Abstract

BackgroundThe objective of this study is to evaluate ‘near miss’ and mortality in women with postpartum infections.MethodsWe performed a retrospective review of all patients referred to the University Teaching Hospital of Kigali (CHUK) between January 2012 and December 2013. We identified 117 patients with postpartum infections. Demographic data, length of admission, location of referral, initial surgery and subsequent treatment modalities including antibiotic administration and secondary surgery were recorded. The primary outcome of interest was a composite of maternal mortality and “near miss” defined as more than one laparotomy with/without hysterectomy and prolonged hospitalization.ResultsDiagnoses at CHUK were: pelvic peritonitis (56 %), deep surgical site infection including fasciitis (17 %), and endometritis (15 %). The primary procedures performed prior to transfer were: cesarean section (81 %), septic abortion management (12 %), and vaginal delivery (7 %). Antibiotics were initiated prior to transfer in 66 % of women. Surgery was required in 73 % of patients. Hysterectomies were performed in 22 % of patients. Maternal death occurred in 5 % of the patient population. The primary outcome of severe maternal morbidity and mortality occurred in 90 patients (77 %).ConclusionPeritonitis—primarily as a result of cesarean deliveries—is associated with significant morbidity and mortality in our population.

Severe maternal outcomes and quality of care at district hospitals in Rwanda– a multicentre prospective case-control study

“…This is the first prospective multicentre case control study combining maternal death and maternal near-miss in Rwandan district hospitals, where geographic access to emergency obstetric care is more of an issue than in Kigali capital city [ 9 , 10 ]. Based on an analysis of SMO that occurred in four district hospitals, this study assessed the quality of care provided, using the WHO criteria adapted to the local context [ 14 , 15 ].…”

Materno-fetal and neonatal outcomes associated with caesarean section delivery in private and public hospitals in low- and middle-income countries: a systematic review

“…Nevertheless, cross-comparative findings reveal that private facilities offer significantly better outcomes in terms of CSD-related maternal mortality [59] and public health institutions show worse outcomes of severe morbimortality versus VD [43,58]. The comparison features show a similar trend while using the Robinson approach for perinatal mortality, neonatal distress, and maternal mortality ratio [44,46,50], or maternal CSD complications [49].…”

Understanding variation in health service coverage and maternal health outcomes among districts in Rwanda – A qualitative study of local health workers’ perceptions

“…It is worth noting that Rwanda has a mechanism in place to conduct maternal death audits, and the country is currently in the process of institutionalizing ‘near-miss’ audits and confidential enquiries into maternal deaths [25]. Some studies recently reported rather high rates of postpartum haemorrhage and infection, as causes of maternal near miss and death [26,27]. This indicates a need for improvement of quality of care at the level of district hospitals, where the majority of deliveries occur.…”